This document discusses hybrid approaches for treating thoracoabdominal aneurysms and aortic arch disease. It describes using endovascular stent grafts in combination with open surgical debranching of visceral arteries. The conclusions state that hybrid procedures may have lower early morbidity than open surgery while providing similar long-term survival outcomes, making them a safer alternative for high-risk patients.

1. Hybrid Approach
Thoracoabdominal Aneurysm
Selim İsbir, MD
Professor of Cardiovascular Surgery
Marmara University
Istanbul

2. Endovascular Patient Anatomy
PND
18 mm – 44 mm
DND
18-44 mm
AVD 8 mm
PNL 15mm
DNL 15 mm

3. Hybrid
Endovascular
Approach
Supraaortic
Extra-anatomic
Bypass
Visseral
“ Debranching”
H-TEVAR

4. TAA – Crawford Classification
I II III IV

5. Visseral Debranching
Ascending Aorta
“Antegrade”
Iliac Artery
“Retrograde”

9. Conclusions. Hybrid debranching procedures may
reduce early morbidity and yield similar late
survival, even in a group considered high risk for
open surgery. These data support the increasing
utilization of a hybrid debranching and
endovascular approach for patients requiring
thoracoabdominal aneurysmectomy.

10. Hybrid repair of complex aortic arch disease
with revascularisation of the supra-aortic
branches prior to stent graft deployment has
evolved as an alternative treatment option for
selected patients who are high surgical risk for
conventional open repair.

15. Conclusion
“Hybrid” open / endovascular approach
•May be performed with lower morbidity and
mortality than conventional repair.
•Appear to be safe alternative to open repair for
thoracoabdominal and aortic arch aneurysms in
properly selected patients with significant
comorbidity or prior open aortic surgery.

16. •Patient demand and
industry push for
minimally invasive
surgery.
•Device availability.
•We have to change.